Anxiety and related disorders: persistent somatoform pain disorder: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Anxiety and related disorders: persistent somatoform pain disorder

Sample item

A 40-year-old man has had severe low back pain for 18 months, with no structural lesion on repeated MRI, and the pain is linked in time to marital conflict. Opioids have not helped. Which is the best pharmacological option?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. A tricyclic antidepressant or duloxetine with psychological support

In persistent somatoform pain disorder, antidepressants with analgesic effect, such as amitriptyline or duloxetine, combined with CBT and graded activity are used. Opioids and benzodiazepines risk dependence without benefit in this disorder.

Option by option

  • A. Benzodiazepines at regular doses

    Benzodiazepines cause dependence and do not treat the pain.

  • B. Long-term strong opioids

    Long-term opioids carry dependence risk and are not effective here.

  • C. A tricyclic antidepressant or duloxetine with psychological support (correct)

    Correct. Antidepressants with analgesic action plus psychological therapy are used.

  • D. Antipsychotic monotherapy

    Antipsychotics are not indicated for a pain disorder.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is C, A tricyclic antidepressant or duloxetine with psychological support. In persistent somatoform pain disorder, antidepressants with analgesic effect, such as amitriptyline or duloxetine, combined with CBT and graded activity are used.

Why is "Benzodiazepines at regular doses" not the answer?

Benzodiazepines cause dependence and do not treat the pain.

Why is "Long-term strong opioids" not the answer?

Long-term opioids carry dependence risk and are not effective here.

Why is "Antipsychotic monotherapy" not the answer?

Antipsychotics are not indicated for a pain disorder.

What concept does this question test?

It tests Anxiety and related disorders: persistent somatoform pain disorder in Psychiatry. Opioids and benzodiazepines risk dependence without benefit in this disorder.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Anxiety and related disorders: persistent somatoform pain disorder?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.